Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1478 | NC |
NPI | 1508079963 |
---|---|
Provider Name | Dr. Danny Lee Tyndall |
First Address | Asheboro, NC 27203-5623 |
Second Address | Asheboro, NC 27203-5623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08881 | BCBS (01) | NC |
8908881 | (05) | NC |
T64496 | (02) | NC |